Child & Adolescent Emotional Wellbeing and Mental Health Needs Assessment

115 Pages·2017·7 MB·English

North East Lincolnshire Council
Child & Adolescent
Emotional Wellbeing
and Mental Health
Needs Assessment
1
Content
Acknowledgements 5
Executive Summary 6
Introduction 12

Purpose and scope of the needs assessment 13
National context 15
Current legislation, policy, guidance and best practice 17
Commissioning Overview 19
Emerging Issues (model) 23
North East Lincolnshire 27

North East Lincolnshire Overview 29
Local strategy, commissioning plans 35
Summary of national data sources and tools
e.g. children’s mental health and wellbeing profile,
relevant PHOF indicators, self-harm, suicide, ALS 39
Literature 53

Purpose and scope of the needs assessment
Risk factors for emotional and mental wellbeing 54
Summary of the Evidence Base 65
2
Service review – existing services 72

Who is commissioning what 73
Who provides what 75
Comprehensive review of all local CAMHS services 75
Mapping of local pathways 83
Vulnerable groups 87
Consultation 90

Key stakeholders consultation regarding experiences,
opinions on met and unmet needs, and recommendations
for service improvement – interviews/ focus groups
Participatory survey – with children and young people
with links to young minds national survey, local Adolescent
Lifestyle Survey and investigation work undertaken
by young advisors
Public consultation – online survey
Findings 105
Conclusion 107
Recommendations for future commissioning
Appendix 1 109
References – Endnotes 112
3
4
Acknowledgements
The Commissioning Support Unit at North East Lincolnshire
Council would like to thank all those organisations who
contributed their time and insight to developing this report.
This includes:
• North East Lincolnshire Council • Navigo
• North East Lincolnshire Clinical • NHS England
Commissioning Group
• North East Lincolnshire schools
• Lincolnshire Partnership
NHS Foundation Trust • North East Lincolnshire Healthwatch
• Northern Lincolnshire and Goole NHS • Humberside Police Force
Foundation Trust
• North East Lincolnshire voluntary and

community sector organisations

A list of those who gave specific feedback via a focus group or
interview is included as Appendix 1.
Special thanks to all the children and young people, acknowledge the children and young people from the
and their parents and carers, who gave up their NSPCC, Youth Action Group and CAMHS User Group,
time to contribute. In particular, we would like to all of whom participated in detailed focus groups.
Thanks are due also to the teaching and non-teaching staff, and school nurses, who
supported and participated in school focus groups, at:
• Middlethorpe Primary Academy • Oasis Academy Immingham
Secondary and Sixth Form
• East Ravendale Church of
England Primary School
• Havelock Academy Secondary
School and Sixth Form
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Executive Summary
Introduction
• Unique Improvements were • The majority of children and young
commissioned by North East people do not access help, and
Lincolnshire Council to undertake a research indicates that there is an
needs assessment of children and 8 year gap between problems first
young people’s emotional and mental being identified and help being secured
health needs, to inform the development
of a new emotional wellbeing and • Mental health, including for children
mental health pathway, in line with the and young people, has been a key
recommendations from Future In Mind governmental priority for some time.
In 2015, the Government launched
• Emotional and mental health problems ‘Future In Mind’, a five-year
are common amongst children and transformation programme for children
young people, with the most recent and young people’s emotional
large scale study estimating that 1 and mental health. Additional
in 10 children and young people will funding has been available to local
suffer from a diagnosable mental areas, linked to the development
health condition at some stage in their of a local transformation plan
childhood. For some young people, their
illness will be severe and ongoing; half • The commissioning arrangements for
of all serious mental illness in adults emotional and mental health services
begins during the later teenage years. are complex, with a coordinated
Some factors (individual, family, social approach required to ensure that needs
and environmental) place children are met in the most efficient way. North
and young people at greater risk of East Lincolnshire has strong multi-
developing poor mental health agency arrangements to ensure that
this coordinated approach is in place
North East Lincolnshire
• There are approximately 38,000 people • North East Lincolnshire is particularly
aged under 20 in North East Lincolnshire. affected by deprivation, and has higher
Population projections suggest that this than average rates of children living in
figure will actually decline slightly over low income families, unemployment,
the next 20 years statutory homelessness and fuel poverty.
This suggests a greater challenge for
emotional and mental health than in more
affluent areas

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• The Public Health Profile for North • The Adolescent Lifestyle Survey which
East Lincolnshire shows that the is carried out in North East Lincolnshire
health and wellbeing of children and provides valuable information about
young people is generally worse than the health and lifestyles of 11-16 year
elsewhere in the country. Of particular olds. In 2015, 4,266 young people
concern are the proportion of school completed a survey. In terms of
leavers attaining 5 or more GCSEs emotional and mental health, the key
at grades A* to C, the proportion of messages are that the majority of young
16 and 17 year olds not in education, people (approximately 85%) generally
employment or training (NEET), the feel happy about life, although the
rate of teenage pregnancy and the rate proportion who report that they worry
of children being looked after by the a lot of the time is increasing. 15% of
local authority. Again, this suggests a young people reported that they would
greater challenge for emotional and hurt themselves if they had a problem
mental health than in other areas – this chimes with what professionals
told us about the concerning level
• We can be clear about the numbers of self-harm locally. There has been
of children and young people known a significant rise in the proportion of
to services from vulnerable groups in young people reporting cyber-bullying
North East Lincolnshire. Of particular
concern to both the Local Authority • The strategic commissioning intentions
and CCG will be the 265 children in for North East Lincolnshire’s children
care, 550 with learning disabilities, and and young people are set out clearly in
441 young people who have offended. a range of plans, including the Future
Figures from the January 2016 school In Mind Local Action Plan, which
census show there were 210 North has been independently evaluated
East Lincolnshire pupils with special positively by the Education Policy
educational needs with an autistic Institute’s Mental Health Commission
spectrum condition as their primary need
• North East Lincolnshire is embarking on
• The National Child and Maternal Health a major re-commissioning of services
Intelligence Network (CHIMAT, part for 0-19 year olds, with much more
of Public Health England) provides emphasis on prevention and early help.
estimates of the prevalence of It has been decided to integrate services
common emotional and mental health for emotional and mental health into
conditions in local areas. For North East this approach. We think this is a very
Lincolnshire, it is estimated that there positive development and will enable
are 2,320 children and young people local family hubs to deal with emotional
aged 5-16 with mental health conditions. and mental health issues as they arise,
Of these, 1,440 will have a conduct as part of an integrated family approach
disorder, 910 will have an emotional
disorder, 385 will have a hyperkinetic
disorder (generally ADHD), and 295 will
have a range of less common disorders
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Literature
• There is now a very strong evidence • There is now a considerable research
base which demonstrates that the base into the needs and experiences
presence of both risk and protective of particularly vulnerable groups
factors, at individual, family, community of children and young people. The
and environmental levels, has a very evidence base is particularly strong
significant impact in determining for looked after children and young
which children and young people will people who have offended
experience poor mental health. Poor
parenting, experiences of abuse and • There is an increasingly sophisticated
neglect, economic deprivation, bullying evidence base for which interventions
and discrimination are key risk factors have been proven to work

• Risk factors tend to accumulate over
time and can be interdependent and
mutually self-reinforcing. Emotional
and mental health problems have a
strong association with other poor
outcomes including truancy and
exclusion, and substance misuse
Service Review
• The Child and Adolescent Mental Health • Despite the development of information
Service is commissioned by North leaflets and a duty advice line, a
East Lincolnshire Council via a Section significant proportion of referrals are not
75 partnership agreement with North accepted for assessment/treatment.
East Lincolnshire CCG. The service is This suggests that the service’s eligibility
provided by Lincolnshire Partnership criteria are not well understood, and
NHS Foundation Trust and has a causes a lot of waste and frustration
contract value of just over £2 million in the system. Further work may be
required with GPs and other referral
• The service has been well evaluated agencies to ensure that referral pathways
by the Care Quality Commission and eligibility criteria are fully understood
and both users and referrers report
a high quality service once a young • A Crisis Intervention Team, which
person has been accepted provides intensive intervention to
young people at risk of inpatient
• The Service provides a comprehensive admission, has been highly effective
range of pathways and treatment at managing young people with
modalities, which adhere to clinical complex needs in the community.
guidance/standards developed by the The use of inpatient facilities is low
National Institute of Clinical Excellence
• Thresholds to receive a service are
very high. Although growing, the
range and capacity of services to
meet lower level needs at an early
stage needs to be further developed
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• There is some concern about the eating • The needs of vulnerable groups are
disorder pathway. The pathway needs to generally well catered for, with specific
be updated to demonstrate how the new teams for looked after children, CYP
waiting time standard is being achieved. with learning disabilities and dedicated
The low numbers of referrals for eating workers linked to the YOT and
disorders is being monitored locally but substance misuse service. However,
we feel this needs some expert input the offer for vulnerable groups is not
comprehensive and it would appear
that young people from the Youth
Offending Team and substance misuse
service with more complex needs are
not getting the support they need
Consultation
• In excess of 300 people gave their • The workforce acknowledges the
views of Children’s and Young people’s issues and has identified training
Emotional and Mental Wellbeing needs to be able to cope better
Services. They were a combination of with issues in the community rather
Commissioners, Managers, Providers, than ‘handing off’ young people
Clinical Staff, Children and Young
People and their parents and carers • There is an acknowledgement of
the complex lives lived by some
• It is accepted that the number of CYP and the effect of the wider
CYP presenting with emotional determinants of health and their families
and mental wellbeing issues is on their ongoing mental health
increasing and the complexity of
their conditions is increasing • Some schools have excellent examples
of support for primary school children
• There appears to be little support which falls off as they get older and
provided for those with low and medium collapse by year 8. Schools are using
level emotional and mental wellbeing exclusion to manage behaviour and
issues. If there is support then it is exclude automatically for single issues.
either over – stretched or unknown to Last year there were 64 exclusions
the system. There needs to be a focus of which 57 remain excluded. Young
on prevention and early intervention people in groups talk about the impact
on a class when the teacher is trying to
• Pathways for emotional and mental manage behavioural issues. Schools do
wellbeing are referred to but nobody not explore underlying issues as they
can produce one. It appears as if don’t have the skills, time or capacity
they possibly existed in the past to do this. Early intervention is entirely
and haven’t been reviewed missing in some schools and parents use
school as first point of call for advice.
• The CAMH service is acknowledged as
There is a perception that the school
a good service if you can access it. The
nursing service is underfunded and
thresholds are too high for the needs of
sometimes there is only a day or two of
the majority of CYP and service providers
provision each month

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Conclusion and Recommendations
• Our conclusion is that currently the • This is acknowledged locally and
system does not meet the needs of highlighted in the local transformation
children and young people with low plan for emotional wellbeing and
level emotional and mental health mental health. The plan recognises
needs well. We think it is probable that the importance of intervening from
this means that a disproportionate the ante-natal period and in the early
number of children and young people years, supporting families and those
tip over into crisis, creating a vicious who care for children and building
cycle where specialist mental health resilience through to adulthood, reducing
resources are focussed on the the demand for specialist services by
smallest group of children and young preventing children growing up and
people with the highest needs experiencing complex family issues

We recommend that:
• The current system is heavily reliant • A key next step will be to engage with
on a specialist CAMH Service. This schools to identify what they are currently
means that only those with the most commissioning/providing to support
severe presentations are assessed and emotional and mental health. A desired
treated. As an integral part of Future outcome would be the commissioning
In Mind implementation, a proactive of a consistent, easily accessible
shift to early intervention and easily schools based service, available to both
accessible support in schools and children and parents on a drop in basis
voluntary sector provision is planned.
This should be reinforced with a much • Support for parents to manage behaviour
greater degree of capacity in services well is the most needed and effective
for the most vulnerable children and intervention for children at the pre-
young people (particularly children in school and primary school phase. NEL
need) to understand and engage with should commission evidence based
emotional and mental health needs. parenting group programmes as part
Referral to CAMHS should become of the core offer in family hubs
the exception rather than the default
• The THRIVE model should be considered
• Where specialist CAMHS are as a way to move away from tiers and
required, they need to be available at ensure that services are arranged around
times which are more convenient to the needs of children and young people
children, young people and families.
Commissioners should consider whether
early morning, evening or weekend
sessions would enable the service
to be more accessible and have less
negative impact on school attendance
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